Amanda Eleazar, of Iowa City, was just 25 years old when she started using opioids. It was 2014, and she was a mother of four living in Tennessee. Her husband received a prescription from a local pain specialist clinic. He ended up addicted to opioids, and she eventually joined him.
After years of addiction, Eleazar and her husband moved to Burlington, Iowa, to start their recovery in a new place. Eventually, they both relapsed. Eleazar’s husband later died of endocarditis, or an infection of the heart, from intravenous drug use.
In 2019, she gave birth to her son at the University of Iowa Health Care Medical Center. With the help of doctors, social workers, and case managers at UIHC, Eleazar was able to retain custody of her son and was released to a sober living home with her son in Cedar Rapids.
“The second that I gave birth was the moment that I realized everything in my brain was quiet, and it was just, ‘What can I do to keep him?’” Eleazar said.
She has since become a recovery coach at UI Health Care, where she provides support to individuals working toward recovery.
Eleazar is one of millions of Americans who have become addicted to opioids, a public health crisis known as the opioid epidemic, or the mass proliferation of
opioid painkillers like OxyContin.
Every year, 80,000 die from opioid overdoses in the U.S., and nearly 9 million misuse opioids, according to the National Center for Drug Abuse Statistics. From April 2024 to April 2025, 422 Iowans died of drug overdose, according to the Centers for Disease Control and Prevention.
On average, 76 percent of drug overdoses are related to opioids nationwide.
Drug manufacturers were found to have intentionally concealed studies and trials from doctors, pharmacists, and the public that proved the addictiveness of opioid painkillers like OxyContin since the drug came onto the market in 1996, according to a New York Times investigation. This resulted in lawsuits led by state attorneys general, who sued pharmaceutical manufacturers and distributors for their role in the opioid epidemic.
The settlements will result in the distribution of $50 billion to state and local governments across the country, according to National Association of Counties. Iowa and local governments are poised to receive $364 million in settlement funds through June 30, 2040, with the state and local governments equally splitting the funds.
Counties began to receive funding in 2022, but many counties are continuing to decide on the programs to be funded with the opioid settlement funding. As of the end of fiscal year 2024, Iowa county governments have received $36.6 million in opioid settlement funding, most of which has gone unspent, with counties appropriating roughly $2 million since beginning to receive funds in fiscal year 2023.
Iowa counties have begun working to spend the millions of opioid settlement funds that sit in their county coffers. Iowa’s largest counties, such as Linn, Polk, and Johnson counties, have led the charge by setting up harm reduction vending machines and doling out grants to local substance use disorder
treatment organizations.
The state is not far behind. Iowa lawmakers passed House File 1038 into law in May, appropriating 75 percent of state opioid settlement funds to the Iowa Department of Health and Human Services and 25 percent to the Iowa Attorney General’s office.
The Iowa Department of Health and Human Services published a request for proposal on Oct. 31, asking for grant applications for opioid settlement funds. The grant closed on Dec. 2; the state is expected to announce its intent to award on Dec. 22.
The attorney general’s office is limited in its ability to use the funds by the memorandum of understanding put in place under the opioid settlement agreement. According to the memorandum, the funds can only be used to support jail diversion programs, connecting those with an opioid addiction to treatment before trial, support treatment and recovery courts, and provide training on best practices for interacting with those suffering from an opioid addicition. However, the attorney general’s office has not publicly announced what the funds will be used for.
Johnson County received over $1.4 million through the end of fiscal 2024, according to the Iowa Association of County Compilation of Reports filed with the attorney general.
Iowa public health departments work to reduce harm with funds
Public health departments in Johnson and Linn counties have dedicated $100,00 and $150,000 from their opioid settlement funds, respectively. The funds were used to distribute naloxone, a drug that reverses an opioid overdose, along with other harm reduction supplies in vending machines placed strategically around the county.
Naloxone binds to the brain’s opioid receptors and blocks opioids from binding with them, stopping the effects of opioids on the nervous system.
Naloxone, containers to dispose of used needles safely, condoms, wound care kits, hygiene products, and gun locks are available at most of the seven specially designated vending machines in Linn County and four located in Johnson County.
These vending machines are aimed at reducing the spread of disease through used needles, unprotected sex, and untreated wounds, Linn County and Johnson County public health officials said. The supplies are free and do not require identification to access.
“If I want people to ever get onto the road of recovery and have a successful recovery, I need to have them as healthy as possible, and I need them to be alive,” Linn County Clinical Services Branch Manager Heather Meador said.
Meador said her team found that nationally, naloxone vending machines have proven effective. A study by Johns Hopkins Bloomberg School of Public Health found that harm reduction vending machines are associated with a reduction in overdose mortality and syringe sharing.
The study found that overdose deaths fall anywhere from 10 to 15 percent when harm reduction vending machines are introduced to a community.
“[Linn County Public Health] saw that a vending machine program where people could access resources at no cost was extremely beneficial and had been shown as a great tool in the opioid epidemic,” she said.
Meador and Sam Jarvis, the community health manager at Johnson County Public Health, both said they aim to reduce the spread of infections, reduce opioid overdoses, and negate the dangers of drug use as much as possible.
Polk County has also installed a machine outside of its public health building in Des Moines that is regularly stocked and monitored. This is in addition to 18 supply boxes around Polk County that contain naloxone.
Jarvis said the vending machines have received a warm welcome in the community and, to him, show a changing tide around the stigma of substance use disorder.
“Folks are understanding the severity and also the different phase that we’re in now with the opioid epidemic,” Jarvis said. “We’re excited to be able to break down those barriers or stigma, and then also educate the public on what opioid misuse really looks like.”
The programs have been effective with Polk County alone distributing over 15,000 doses of naloxone, including 126 confirmed overdose reversals, according to data provided by Polk County. Linn County has given out 4,000 boxes of naloxone, and Johnson County has distributed 452 boxes.
Linn, Polk County lead in partnering with local organizations
Linn and Polk counties have made large grant awards from opioid settlement funds this year as they look to distribute the funds to organizations that work directly with those who suffer from opioid use disorder, the medical term for opioid misuse.
Polk County has implemented a wide variety of programs aimed at a variety of purposes of the funds delineated under the national settlement agreement. One main area of focus was ensuring that individuals with opioid use disorder who interact with the criminal justice system in Polk County get the support they need, Gabbie Ruggiero, a Polk County Behavioral Health and Disability Services program planner, said.
This includes a handoff kiosk at the Polk County Jail for an easy transition to behavioral health services like recovery programs, naloxone distribution at the jail, jail diversion programs, and wrap-around supports — including food, housing, and other basic needs — for those suffering from opioid use disorder.
The programs funded by the Polk County Board of Supervisors also include prevention, peer support, and treatment services, along with support for those with lived experience.
“We are looking at other places we need to be more intentional about spending the funds and making sure that we’re encompassing all of the core strategies from the national settlement,” Ruggiero said.
Like Polk County, Linn County has partnered with several community organizations to utilize opioid settlement funding, including local mental health providers, the Linn County Sheriff’s Office for a jail diversion program, wrap-around support for those suffering from opioid use disorder, and community partners focused on prevention and education.
However, Meador and Jarvis said this isn’t the end of the line for the county public health department’s participation in combating the opioid epidemic. Linn and Johnson counties have been selected as Overdose to Action grantees to use overdose data to combat the opioid epidemic. The program aims to build cooperation across public health, behavioral health, health systems, community organizations, and public safety.
Johnson County to partner with community to decide future of funds
Johnson County has committed $100,000 opioid settlement funds for the naloxone vending machine program and $10,000 for a community needs assessment to gauge where funding might be the most helpful.
However, the Johnson County Board of Supervisors have yet to award grants to community partners. Genevieve Anglin, the grants manager at Johnson County, said the county is working with community partners on creating an advisory committee to advise the county on the best use of the funds.
Anglin said the county wants to consult places that “are the boots on the ground” to help determine the scope, scale, and most “concrete ways that we can make a difference in this crisis.”
“It’s high time for Johnson County to start really looking at this problem, taking the money that we have in the bank, and figuring out the best way to move forward,” Anglin said.
Like Johnson County, Ruggiero said Polk County is looking to continue engaging with people with lived experience to guide where the settlement money goes.
“We wanted to focus on getting the funds into the hands of people who are affected by the opioid epidemic, or are helping people who are affected by the opioid epidemic,” Ruggiero said. “Because ultimately, these funds are because of the proliferation of opioids and opioid addiction and the folks that have died due to overdose and long-term addiction.”
Eleazar, the addiction recovery coach at UIHC, said the use of funds on overdose reversal agents and on community resources is great. But she sees the greatest needs being basic needs — like housing and food — following recovery as an important part of starting to fix what the opioid epidemic has wrought across the U.S.
“We need more recovery homes, we need more housing support. The basic needs need to be met for people to succeed,” Eleazar said. “I think sometimes people forget about that and think, ‘Oh, they’re sober,’ and that everything else falls in place. It doesn’t really work that way.”